Optimising Surveillance and the Delivery of Targeted Interventions to Achieve Malaria Elimination in Eastern Myanmar

Rae, Jade D D (2024). Optimising Surveillance and the Delivery of Targeted Interventions to Achieve Malaria Elimination in Eastern Myanmar. PhD thesis The Open University.

DOI: https://doi.org/10.21954/ou.ro.00096144

Abstract

Malaria elimination is possible with the existing tools, however, control efforts must be accelerated while these tools remain effective due to the emergence and spread of antimalarial-resistant Plasmodium falciparum parasites. The timely collection and analysis of surveillance data allow programs to monitor and respond to decreases in the early uptake of diagnosis and treatment services and increases in incidence and is, therefore, essential in delivering an effective malaria elimination strategy. This thesis describes the collection and analysis of surveillance data used to support the operation of 1,261 malaria posts in the Malaria Elimination Task Force (METF) program in Karen State, Myanmar. Since the commencement of the METF program, there have been significant declines in P. falciparum incidence across Karen State, malaria testing rates have remained stable, and the majority of individuals have continued to seek malaria testing within 48 hours of fever onset. This has all been possible in an area of political and geographic complexity and during periods of disruption (COVID-19 village lockdowns in 2020 and the ongoing military coup in Myanmar, which began in 2021). These findings highlight the importance of accessible, village-based malaria posts and ongoing community engagement activities to maintain service uptake as malaria incidence declines. With declines in P. falciparum incidence, the emergence of high transmission foci has prevented local elimination. In the central West of Northern Karen State, persistent foci in 2021 were identified using a data-driven approach utilising routinely collected surveillance data. Additional targeted interventions can accelerate elimination efforts in these hard-to-control areas. However, the effectiveness of these interventions is likely determined by a range of context-specific factors. Despite the many obstacles, the delivery of an effective malaria elimination program can be supported by the continued collection and utilisation of detailed surveillance data, which promote the acceleration of malaria elimination efforts in Karen State and globally.

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